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IX. THE BEST JOB IN THE WORLD?
566
The Widdicombe File IX. THE BEST JOB IN THE WORLD ?? DEAR BILL,
Thank you for your letter. I sympathise with you. A G.P.’S life during the first three months of the year, with epidemics treading on each other’s heels, with long journeys in sleet and mud to outlying villages, can be hell ; but in summer it can be idyllic. Your comparison between the thorny path that you are treading at the moment and the bed of roses on which you imagine me to be reclining is very wide of the mark. *
*
*
I couldn’t describe a typical day in my life, because no day is typical. A surgeon’s chief jobs are to examine patients and advise on their treatment, to operate on those who need operation, to care for them after operation, and to keep in touch with them afterwards for as long as they need supervision. None of these things An can be done even approximately to schedule. outpatient morning may bring a string of straightforward lumps, hernise, and hydroceles one day, another day a series of difficult problems, where the essential facts must be extracted by insistent questioning from a mass of irrelevant detail poured out in excitable and broken English, where tests must be carried out and laboratory reports and X-ray films must be studied-before it can be decided if the patient must be admitted or can be seen again at the next session. One sets aside certain times for private consultations ; but there may be long periods when the practice seems to have died for ever, other times when for weeks on end patients from every corner are clamouring for appointments, and trunk calls from distant shires and arrivals by air from overseas are threatening to drive an overworked secretary and harassed wife to resignation and divorce. The same uncertainty affects operations. One week nothing but minor routine procedures appear on the list, and of these some fail to turn up, some refuse operation, and some are put off because of a cold. At another time a series of heavy operations lasting three or four hours apiece and making the severest call on one’s nerve and physical stamina must be fitted in ; and, as luck would have it, the easy operation that has been put in to make the list less onerous presents some unexpected complication that imposes a change of plan, or a ligature slips off a deeply placed artery just as the abdomen is about to be closed and demands urgent action and transfusion, or, at the close of a heavy day when the team and the sisters are dropping with fatigue, the swab count is wrong, and only after repeated hunting round the abdomen and the theatre does the missing bit of gauze appear between the heel and sole of the dresser’s rubber boot. The aftercare of a patient in a nursing-home or at a distance may double the surgeon’s work and anxiety for an indefinite period. He is called on an emergency twenty miles away. He finds a man of 65 who has had two coronary attacks and is living carefully. For three days this old man has been feeling off colour, disliking his food but not sick, constipated and blown up, but That morning he took a dose of salts. not in pain. Two hours later he felt a violent pain in the lower part of his abdomen and collapsed. He has been very ill On examining this old man the indeed ever since. surgeon finds that he has general peritonitis. His temperature is just under 100, his pulse-rate is 120, the lower half of his abdomen is rigid, and no peristaltic Rectal examination reveals a sounds can be heard. ballooned rectum. Clearly the aperient burst a localised appendix abscess. The old man is almost certain to die, but the one sure way to kill him is by operating. He! requires almost hourly-at any rate twice-daily-super,
vision for the next ten days. His temperature, pulse, and respiration must be charted two-hourly, and his fluid balance daily. He must be put on intravenous fluids, and the correct amount of fluids ; and the balance between crystalloids, plasma, and blood must be con. tinuallyassessed and adjusted with the help of chloride and serum-protein estimations, haematocrit readings, and urine charts, as well as by the appearance of his tongue, the sound of his chest, and the clinical evidence of dehydration. Continuous suction through an indwelling gastric tube must be instituted, and if distension increases it may be necessary to change the Ryle tube for a Miller-Abbott. Morphine is wanted all the time-enough to keep him quiet, not enough to dull his respiratorv centre. He must be bullied into moving all the time, or his chest will kill him before his abdomen. His abdomen must be listened to for the first sounds of hope. A daily examination of the belly for the localisation of an abscess in the left iliac fossa, and a daily rectal examination to detect pus pointing in the rectovesical pouch, are equally necessary. For ten days letters are answered in the small hours of the morning and social engagements are scrapped, till a gush of pus per rectum or a fine fanfare of flatus tells the surgeon that he can relax again and return to normal routine. *
*
*
All this is fun. All this is in the day’s work. But there is a great deal of work that is not fun. There are reports to be made out, letters to be written, testi. monials to be composed, references on candidates pro. vided to regional boards, lectures to be given and listened to, journals and books to be read, social func. tions such as the dinners of hospital societies and corporations to be attended-worst of all, committees of every kind and the profuse agenda that must be digested before each. The more senior a surgeon becomes, the more do his non-clinical duties pile upon him, though his clinical ones remain as heavy. The senior surgeon is a beast of burden who seldom sees a carrot. I have just looked through my diary for the first six weeks of this year. In that period I spent 460 hours at my job-that is, an average of 11 hours a day, including Sundays. Breaking up this time, I find that 31% only was spent on clinical work, seeing patients and operating ; 20% on committees or lectures; 27% on book work or writing (that is, reading in libraries or preparing lectures or articles) ; 14% in transport (getting from one job to the next), and 7% on surgicalsocial engagements. Of his work, the 27% spent in reading and writing is far the most exhausting, for it demands the most intense concentration, and it must be done against time, and usually when rest and relaxation would be very welcome. The distribution of a surgeon’s work changes as he gets older, but its quantity increases all the time. He sees as many outpatients, and hopes to see as many private patients, as when he was first appointed to his hospital ; but he has more beds and the problems he is asked to advise upon, and the operations he is asked to do, become increasingly onerous. The straightforward jobs go to his junior. The major undertakings, the advanced growths, the third or fourth recurrences, and other people’s failures-all these come to him. In addition he is asked to lecture in many places beside his own hospital, and he can no longer rely on the inspiration of the moment as he did as an assistant surgeon,’but must spend many hours on preparation. He may be expected to contribute leaders, articles, and chapters, and to write books. He is put on many more committees, and can no longer rely on skimming the agenda while someone else is talking, but must go fully briefed. On the other hand, he has by now learnt the folly of reading overmuch. A new idea is sometimes good, often rubbish, and usually valuable only when it has been
567
sifted, assessed, and modified over several years. A new operation can only be judged in conjunction with the status of its propounder, and after seeing it performed by him and studying the patient afterwards. The surgical aspirant who does not read four hours a day will never get through the Fellowship. The surgeon who ten years after certification is still putting other people’s ideas into his head for four hours a day has
ceased, or will soon cease, to have any of his own. The mature surgeon acquires further knowledge from conversing with his sisters, his students, and his colleagues, If anything worth and from visiting other centres. while has appeared he will hear it, and he will hear it already digested and summarised for his benefit ; if he wants to know more, then is the time to turn to the
original.
*
*
*
A
surgeon’s year consists of 365 days, all entirely different; on some of them he longs to retire, on some of them he is half in love with easeful death, on most of them he glories in having the best job in the world. Your old friend, DANIEL WHIDDON.
Parliament Diesel Exhaust Gases IN the House of Lords on March 2, Lord LucAS OF CHILWORTH asked whether the Government would enforce the law on the emission of exhaust gases from diesel engines fitted to road vehicles. The diesel engine was now used in almost all the heavy vehicles on the roads. If the spread continued-and we should soon see diesel engines fitted to private cars-what was now a nuisance would become a menace. In 1950 over 161/2 million man-hours were lost to industry because of bronchitis, and one of the causes of bronchitis was probably air pollution. Again the increase in lung cancer was thought to point to some new and potent environmental factor, and atmospheric pollution, in particular from the exhaust fumes of the internal combustion and diesel engines, was a suspect. Lord LLOYD, joint parliamentary under-secretary of State to the Home Office, thought that on the whole little of the air pollution in towns was due to diesel smoke. According to the report of the Committee on Air Pollution, diesel engines produced 20,000-40,000 tons of sulphur dioxide every year out of the total of 5.3 million tons emitted into the atmosphere. He felt that, at the moment at any rate, diesel smoke did not create a great deal of pollution in the towns. The main places where they emitted clouds of smoke was on the main roads outside the towns. Speaking as one who had often driven behind a lorry, he admitted that diesel smoke could be a menace both to public health and to road safety. At the moment he thought the greatest danger was to road safety.
QUESTION TIME Part-time Consultants Dr. BARNETT STROSS asked the Minister of Health how many of the regional boards allowed transfer from whole-time to part-time consultant medical service.-Mr. IAIN MACLEOD replied : All do in suitable cases, subject to the needs of the service. Dr. Srsoss : Has the Minister noted that the service is not normally well served, or best served, by men in full-time service transferring to part-time service ? Would the Minister give some further thought to, or direction in, this matter ? Mr. MACLEOD : I do not think that any such generalisations can be drawn. The policy which I have indicated is based on the 1948 circular, and there has been no change in that. I believe that a part-time consultant service is a very good thing, and I have certainly no evidence to show that there is any deterioration in the service provided to the people. Mr. ARTHUR BLENKiNSO? : Is the Minister aware that he is giving some encouragement to the transfer from full-time to part-time service ? Are not some regional boards offering the maximum number of part-time sessions as an alternative to full-time sessions, to the great detriment of the service and
?-Mr. MACLEOD : Boards may well interpret circulars-in particular the 1948 circular-in different ways ; there are different trends in different regional boards. I have no reason to think, however, that the boards are not applying their general policy to individual cases-which is what matters-in a reasonable manner. Dr. STROSS: Will the Minister give an estimate of the financial saving that would follow the abolition of the parttime consultant service and its replacement by a service employing only full-time specialists ?-Mr. MACLEOD : I do not think the financial effect of such a hypothetical circumstance can possibly be assessed. Dr. STROSS: Is the Minister aware that some of us think that the saving would be considerable ? Full-time consultants are not allowed any of the perquisites, such as expense allowances, and so on, that follow part-time service. If there could be a switch-over to full-time service would it not be possible to make that service more attractive even financially ?-Mr. MACLEOD : Remuneration of all forms is treated rather differently as between wholetime and part-time specialists ; that goes back to the Spens report. The first part of the hon. member’s supplementary question is in direct conflict with the 1949 amending Act. Any suggestion of part-time service being abolished would certainly be a breach of faith with the profession. Mr. HASTINGS : Would not the withdrawal of travelling time and expenses payments, which apply only to part-time officers, save a lot of money and give the Minister an opportunity to improve the service in other directions ?-Mr. MACLEOD : I understand the point but I do not agree with it. Mr. BLENKINSOP asked the Minister whether he was aware of the financial advantages enjoyed by part-time specialists employed by hospital authorities in comparison with those employed full-time ; and whether he would refer the matter to the Guillebaud committee in view of the heavy cost of payments for travelling time and domiciliary visits charged by part-time specialists.-Mr. MACLEOD replied : I am aware of the arrangements which were agreed in 1949. It is open to the Guillebaud committee to consider this point, but I do not think it would be appropriate for me to ask them to inquire into particular topics. If there is to be any adjustment in these terms and conditions of service, it is better left in the ordinary way to the Whitley Council, where it can be fully discussed, and is being discussed in connection with the claim before the medical Whitley Council. I think that is a better forum than the Guillebaud committee. to its added cost
Salaries of Consultants and Specialists Mrs. JEAN MANN asked the Minister what negotiations were in progress regarding salary-scales of consultants, senior hospital medical officers, and registrars.-Mr. MACLEOD replied : A claim for higher salaries is before the medical Whitley Council. This matter has been under consideration for 16 or 17 months, a very long time indeed, but I think we are now nearing a conclusion. This is a matter of profound importance which will have repercussions in many other fields. Retrenchment in Plymouth Mr. M. M. FOOT asked the Minister what cuts in services he expected the Plymouth, South Devon, and East Cornwall Hospital Management Committee would have to make as a result of the money allocated for 1954-55 by the regional hospital board.-Mr. MACLEOD : I understand that the board is considering with the committee the possibility of closing two units which are not fully used, but it does not at present appear that there need be any reduction in adequate services.Mr. FOOT : Is the Minister aware that when he talks about two units not fully used, what he really means is that his policy is to compel the Plymouth board and the area management committee to close down two maternity hospitals and another hospital which have been part of the expansion campaign over the last few years ? Indeed, he is compelling the management committee in this area to reverse the policy of previous years and to cut down the hospital services in the whole area.-Mr. MACLEOD : I do not accept that for one moment. The allocation to this hospital management committee, as I said before, has, in fact, gone up and not down. The first reaction of Mr. Medland, the chairman, was to say that he would be compelled to close two maternity homes, a trainingschool, and a hospital for the chronic sick. If that is the reaction ta an offer to increase moneys we must look very carefully into the administration there.-Mr. FOOT : Would the Minister take into account that Mr. Medland has had the full support of his management committee in stating that the
The Widdicombe File IX. THE BEST JOB IN THE WORLD ?? DEAR BILL,
Thank you for your letter. I sympathise with you. A G.P.’S life during the first three months of the year, with epidemics treading on each other’s heels, with long journeys in sleet and mud to outlying villages, can be hell ; but in summer it can be idyllic. Your comparison between the thorny path that you are treading at the moment and the bed of roses on which you imagine me to be reclining is very wide of the mark. *
*
*
I couldn’t describe a typical day in my life, because no day is typical. A surgeon’s chief jobs are to examine patients and advise on their treatment, to operate on those who need operation, to care for them after operation, and to keep in touch with them afterwards for as long as they need supervision. None of these things An can be done even approximately to schedule. outpatient morning may bring a string of straightforward lumps, hernise, and hydroceles one day, another day a series of difficult problems, where the essential facts must be extracted by insistent questioning from a mass of irrelevant detail poured out in excitable and broken English, where tests must be carried out and laboratory reports and X-ray films must be studied-before it can be decided if the patient must be admitted or can be seen again at the next session. One sets aside certain times for private consultations ; but there may be long periods when the practice seems to have died for ever, other times when for weeks on end patients from every corner are clamouring for appointments, and trunk calls from distant shires and arrivals by air from overseas are threatening to drive an overworked secretary and harassed wife to resignation and divorce. The same uncertainty affects operations. One week nothing but minor routine procedures appear on the list, and of these some fail to turn up, some refuse operation, and some are put off because of a cold. At another time a series of heavy operations lasting three or four hours apiece and making the severest call on one’s nerve and physical stamina must be fitted in ; and, as luck would have it, the easy operation that has been put in to make the list less onerous presents some unexpected complication that imposes a change of plan, or a ligature slips off a deeply placed artery just as the abdomen is about to be closed and demands urgent action and transfusion, or, at the close of a heavy day when the team and the sisters are dropping with fatigue, the swab count is wrong, and only after repeated hunting round the abdomen and the theatre does the missing bit of gauze appear between the heel and sole of the dresser’s rubber boot. The aftercare of a patient in a nursing-home or at a distance may double the surgeon’s work and anxiety for an indefinite period. He is called on an emergency twenty miles away. He finds a man of 65 who has had two coronary attacks and is living carefully. For three days this old man has been feeling off colour, disliking his food but not sick, constipated and blown up, but That morning he took a dose of salts. not in pain. Two hours later he felt a violent pain in the lower part of his abdomen and collapsed. He has been very ill On examining this old man the indeed ever since. surgeon finds that he has general peritonitis. His temperature is just under 100, his pulse-rate is 120, the lower half of his abdomen is rigid, and no peristaltic Rectal examination reveals a sounds can be heard. ballooned rectum. Clearly the aperient burst a localised appendix abscess. The old man is almost certain to die, but the one sure way to kill him is by operating. He! requires almost hourly-at any rate twice-daily-super,
vision for the next ten days. His temperature, pulse, and respiration must be charted two-hourly, and his fluid balance daily. He must be put on intravenous fluids, and the correct amount of fluids ; and the balance between crystalloids, plasma, and blood must be con. tinuallyassessed and adjusted with the help of chloride and serum-protein estimations, haematocrit readings, and urine charts, as well as by the appearance of his tongue, the sound of his chest, and the clinical evidence of dehydration. Continuous suction through an indwelling gastric tube must be instituted, and if distension increases it may be necessary to change the Ryle tube for a Miller-Abbott. Morphine is wanted all the time-enough to keep him quiet, not enough to dull his respiratorv centre. He must be bullied into moving all the time, or his chest will kill him before his abdomen. His abdomen must be listened to for the first sounds of hope. A daily examination of the belly for the localisation of an abscess in the left iliac fossa, and a daily rectal examination to detect pus pointing in the rectovesical pouch, are equally necessary. For ten days letters are answered in the small hours of the morning and social engagements are scrapped, till a gush of pus per rectum or a fine fanfare of flatus tells the surgeon that he can relax again and return to normal routine. *
*
*
All this is fun. All this is in the day’s work. But there is a great deal of work that is not fun. There are reports to be made out, letters to be written, testi. monials to be composed, references on candidates pro. vided to regional boards, lectures to be given and listened to, journals and books to be read, social func. tions such as the dinners of hospital societies and corporations to be attended-worst of all, committees of every kind and the profuse agenda that must be digested before each. The more senior a surgeon becomes, the more do his non-clinical duties pile upon him, though his clinical ones remain as heavy. The senior surgeon is a beast of burden who seldom sees a carrot. I have just looked through my diary for the first six weeks of this year. In that period I spent 460 hours at my job-that is, an average of 11 hours a day, including Sundays. Breaking up this time, I find that 31% only was spent on clinical work, seeing patients and operating ; 20% on committees or lectures; 27% on book work or writing (that is, reading in libraries or preparing lectures or articles) ; 14% in transport (getting from one job to the next), and 7% on surgicalsocial engagements. Of his work, the 27% spent in reading and writing is far the most exhausting, for it demands the most intense concentration, and it must be done against time, and usually when rest and relaxation would be very welcome. The distribution of a surgeon’s work changes as he gets older, but its quantity increases all the time. He sees as many outpatients, and hopes to see as many private patients, as when he was first appointed to his hospital ; but he has more beds and the problems he is asked to advise upon, and the operations he is asked to do, become increasingly onerous. The straightforward jobs go to his junior. The major undertakings, the advanced growths, the third or fourth recurrences, and other people’s failures-all these come to him. In addition he is asked to lecture in many places beside his own hospital, and he can no longer rely on the inspiration of the moment as he did as an assistant surgeon,’but must spend many hours on preparation. He may be expected to contribute leaders, articles, and chapters, and to write books. He is put on many more committees, and can no longer rely on skimming the agenda while someone else is talking, but must go fully briefed. On the other hand, he has by now learnt the folly of reading overmuch. A new idea is sometimes good, often rubbish, and usually valuable only when it has been
567
sifted, assessed, and modified over several years. A new operation can only be judged in conjunction with the status of its propounder, and after seeing it performed by him and studying the patient afterwards. The surgical aspirant who does not read four hours a day will never get through the Fellowship. The surgeon who ten years after certification is still putting other people’s ideas into his head for four hours a day has
ceased, or will soon cease, to have any of his own. The mature surgeon acquires further knowledge from conversing with his sisters, his students, and his colleagues, If anything worth and from visiting other centres. while has appeared he will hear it, and he will hear it already digested and summarised for his benefit ; if he wants to know more, then is the time to turn to the
original.
*
*
*
A
surgeon’s year consists of 365 days, all entirely different; on some of them he longs to retire, on some of them he is half in love with easeful death, on most of them he glories in having the best job in the world. Your old friend, DANIEL WHIDDON.
Parliament Diesel Exhaust Gases IN the House of Lords on March 2, Lord LucAS OF CHILWORTH asked whether the Government would enforce the law on the emission of exhaust gases from diesel engines fitted to road vehicles. The diesel engine was now used in almost all the heavy vehicles on the roads. If the spread continued-and we should soon see diesel engines fitted to private cars-what was now a nuisance would become a menace. In 1950 over 161/2 million man-hours were lost to industry because of bronchitis, and one of the causes of bronchitis was probably air pollution. Again the increase in lung cancer was thought to point to some new and potent environmental factor, and atmospheric pollution, in particular from the exhaust fumes of the internal combustion and diesel engines, was a suspect. Lord LLOYD, joint parliamentary under-secretary of State to the Home Office, thought that on the whole little of the air pollution in towns was due to diesel smoke. According to the report of the Committee on Air Pollution, diesel engines produced 20,000-40,000 tons of sulphur dioxide every year out of the total of 5.3 million tons emitted into the atmosphere. He felt that, at the moment at any rate, diesel smoke did not create a great deal of pollution in the towns. The main places where they emitted clouds of smoke was on the main roads outside the towns. Speaking as one who had often driven behind a lorry, he admitted that diesel smoke could be a menace both to public health and to road safety. At the moment he thought the greatest danger was to road safety.
QUESTION TIME Part-time Consultants Dr. BARNETT STROSS asked the Minister of Health how many of the regional boards allowed transfer from whole-time to part-time consultant medical service.-Mr. IAIN MACLEOD replied : All do in suitable cases, subject to the needs of the service. Dr. Srsoss : Has the Minister noted that the service is not normally well served, or best served, by men in full-time service transferring to part-time service ? Would the Minister give some further thought to, or direction in, this matter ? Mr. MACLEOD : I do not think that any such generalisations can be drawn. The policy which I have indicated is based on the 1948 circular, and there has been no change in that. I believe that a part-time consultant service is a very good thing, and I have certainly no evidence to show that there is any deterioration in the service provided to the people. Mr. ARTHUR BLENKiNSO? : Is the Minister aware that he is giving some encouragement to the transfer from full-time to part-time service ? Are not some regional boards offering the maximum number of part-time sessions as an alternative to full-time sessions, to the great detriment of the service and
?-Mr. MACLEOD : Boards may well interpret circulars-in particular the 1948 circular-in different ways ; there are different trends in different regional boards. I have no reason to think, however, that the boards are not applying their general policy to individual cases-which is what matters-in a reasonable manner. Dr. STROSS: Will the Minister give an estimate of the financial saving that would follow the abolition of the parttime consultant service and its replacement by a service employing only full-time specialists ?-Mr. MACLEOD : I do not think the financial effect of such a hypothetical circumstance can possibly be assessed. Dr. STROSS: Is the Minister aware that some of us think that the saving would be considerable ? Full-time consultants are not allowed any of the perquisites, such as expense allowances, and so on, that follow part-time service. If there could be a switch-over to full-time service would it not be possible to make that service more attractive even financially ?-Mr. MACLEOD : Remuneration of all forms is treated rather differently as between wholetime and part-time specialists ; that goes back to the Spens report. The first part of the hon. member’s supplementary question is in direct conflict with the 1949 amending Act. Any suggestion of part-time service being abolished would certainly be a breach of faith with the profession. Mr. HASTINGS : Would not the withdrawal of travelling time and expenses payments, which apply only to part-time officers, save a lot of money and give the Minister an opportunity to improve the service in other directions ?-Mr. MACLEOD : I understand the point but I do not agree with it. Mr. BLENKINSOP asked the Minister whether he was aware of the financial advantages enjoyed by part-time specialists employed by hospital authorities in comparison with those employed full-time ; and whether he would refer the matter to the Guillebaud committee in view of the heavy cost of payments for travelling time and domiciliary visits charged by part-time specialists.-Mr. MACLEOD replied : I am aware of the arrangements which were agreed in 1949. It is open to the Guillebaud committee to consider this point, but I do not think it would be appropriate for me to ask them to inquire into particular topics. If there is to be any adjustment in these terms and conditions of service, it is better left in the ordinary way to the Whitley Council, where it can be fully discussed, and is being discussed in connection with the claim before the medical Whitley Council. I think that is a better forum than the Guillebaud committee. to its added cost
Salaries of Consultants and Specialists Mrs. JEAN MANN asked the Minister what negotiations were in progress regarding salary-scales of consultants, senior hospital medical officers, and registrars.-Mr. MACLEOD replied : A claim for higher salaries is before the medical Whitley Council. This matter has been under consideration for 16 or 17 months, a very long time indeed, but I think we are now nearing a conclusion. This is a matter of profound importance which will have repercussions in many other fields. Retrenchment in Plymouth Mr. M. M. FOOT asked the Minister what cuts in services he expected the Plymouth, South Devon, and East Cornwall Hospital Management Committee would have to make as a result of the money allocated for 1954-55 by the regional hospital board.-Mr. MACLEOD : I understand that the board is considering with the committee the possibility of closing two units which are not fully used, but it does not at present appear that there need be any reduction in adequate services.Mr. FOOT : Is the Minister aware that when he talks about two units not fully used, what he really means is that his policy is to compel the Plymouth board and the area management committee to close down two maternity hospitals and another hospital which have been part of the expansion campaign over the last few years ? Indeed, he is compelling the management committee in this area to reverse the policy of previous years and to cut down the hospital services in the whole area.-Mr. MACLEOD : I do not accept that for one moment. The allocation to this hospital management committee, as I said before, has, in fact, gone up and not down. The first reaction of Mr. Medland, the chairman, was to say that he would be compelled to close two maternity homes, a trainingschool, and a hospital for the chronic sick. If that is the reaction ta an offer to increase moneys we must look very carefully into the administration there.-Mr. FOOT : Would the Minister take into account that Mr. Medland has had the full support of his management committee in stating that the